Length of hospital stay is one of the greatest variables between NHS trusts. By reviewing and improving admission and discharge processes, trusts can improve the patient experience by reducing the number of days spent in hospital, and save bed days thus increasing capacity and saving money.
As a measure of the scope for improving length of stay we have looked at the number of bed days beyond the average length of stay for each of combination of Healthcare Resource Group, age, sex and social deprivation. We have taken a quarter of this figure as being an achievable level of improvement and expressed it as a percentage of all the Payment by Results bed days at the trust.
The figures are intended to give an idea of the potential for improvement. However, some hospitals would expect to have patients stay longer than the average for patients with the same age, sex and other characteristics. For example, within each HRG some hospitals (eg specialist trusts) may have more complex patients. Also trusts which serve large geographical areas, with patients travelling long distances, may need to have patients stay longer.
There is usually more variation between hospitals in the pattern of discharge than in the pattern of admission. For all hospitals, discharge rates generally peak on Fridays and drop steeply during the weekend. While patients are admitted seven days a week as emergency admissions, most are discharged on five. For patients admitted as an emergency, the reduction in discharges over the weekend compared to weekdays varies from over 75% to less than 15%.
The day of admission also affects the length of time patients with similar clinical requirements stay in hospital. A patient who is admitted on a Friday may have a length of stay 25% longer than a patient admitted on a Tuesday.
Reducing length of stay will reduce the cost per patient episode, the risk of patients being exposed to hospital acquired infections, A&E waits, cancelled elective procedures and waiting times for treatment thus improving clinical outcomes.
This indicator shows a percentage bed day saving and associated financial productivity opportunity to be realised by amending processes such that the length of stay of patients over the median value for the casemix group is reduced by 25%. This is expressed as a percentage of all PbR spell bed days in the trust. The data is stratified so that patients of similar age, deprivation, HRG and gender are compared with one another. The bed day saving and productivity opportunity is calculated at the granular level before being aggregated and a provider is likely to show a saving opportunity unless all lengths of stay are below the relevant median value.
The following information is displayed for Reducing Length of Stay.
Latest value - Percentage bed days in excess
Financial Opportunity - This shows the financial value of the number of bed days in excess of the percentile value shown. This is calculated by multiplying the excess bed days by the excess bed day tariff.
Volume Opportunity - This shows the number of bed days that have been used to calculate the financial opportunity based on the percentile value shown.
Rank - This shows the position of the trust when ranked against all trusts.